Basal insulin: insulin pumps Dr Emma Wilmot MB ChB BSc (hons) PhD - - PowerPoint PPT Presentation

Supported by a restricted educational grant from Abbott

Basal insulin: insulin pumps

Dr Emma Wilmot

MB ChB BSc (hons) PhD FRCP

Consultant Diabetologist, University Hospitals of Derby and Burton Chair, ABCD Diabetes Technology Network UK

Dr Emma Wilmot

• Chair, Diabetes Technology Network UK
• Consultant Diabetologist, University Hospitals of Derby and Burton,

England UK

• Honorary Assistant Professor (consultant), University of Nottingham
• DAFNE Executive board member

Disclosures: Personal fees and educational grants from: Diabetes Care, Boehringer Ingelheim, Dexcom, Diasend, Eli Lilly, Medtronic, Novo Nordisk, Roche, Sanofi Aventis.

Learning objectives

• Understand the desired effect of basal insulin on

glucose levels

• Feel more confident adjusting basal insulin in

response to FreeStyle Libre traces

• Understand which factors change insulin

requirements

Insulin Pump Basal Insulin

• The role of basal insulin is to keep glucose steady

when not eating and to provide 24 hour coverage

• On an insulin pump the basal rate can be set hour to

hour meet the needs of the individual throughout the day

• Many need higher basal rates in the morning and

lower rates later in the day

Insulin Pump Basal Insulin

• Blood insulin levels reach a steady state 2-5 hours

after a basal rate change

https://abcd.care/dtn-uk-best-practice-guides

Assessing basal insulin

Pump basal rate testing

• The FreeStyle Libre helps with basal rate testing by

providing 24/7 insight into glucose levels

• Basal rates are best assessed on ‘normal days’
• Many factors can change insulin requirements: stress,

alcohol, illness, exercise etc.

Basal insulin dose correct

• To assess whether the basal

rate is correct, look at the glucose trace overnight

• If the basal rate is correct, the

glucose level should stay stable overnight

Basal insulin rate too low

• If the basal rate is too low, the

glucose will rise

• A recurrent rise in glucose
• vernight can mean the basal

rate needs to be increased

Increasing the basal

• Identify when the glucose starts

to rise and increase the basal rate 2 hours before this

• This person has noticed a

recurrent rise in their glucose from 3am-7am

• They should increase their basal

from 1am-5am

Basal insulin rate too high

• If the basal insulin dose is too

high, the glucose will fall

• vernight
• A recurrent fall in glucose
• vernight can mean the basal

rate needs to be decreased, usually 2 hours before the fall begins

Reducing the basal

• Identify when the glucose starts

to fall and reduce the basal rate 2 hours before this

• This person has noticed a

recurrent fall in their glucose from 3am-6am

• They should decrease their

basal rate from 1am-4am

Dawn Phenomenon

• Glucose can increase in the

morning before waking - the Dawn Phenomenon

• Identify when the glucose

starts to rise and increase the basal rate 2 hours before this

• This person has noticed a

recurrent rise in their glucose around 3-7am

• They should increase their

basal rate from 1am-5am

Dawn Phenomenon

• A high, flat glucose
• vernight is often not

a sign that the basal insulin is a problem

• Snacking in the

evening is a common cause

• Aim for an in target

glucose pre-bed

High morning glucose?

Daytime basal rate testing

• You can check the basal rate

during the day by skipping a meal and observing the FreeStyle Libre trace

• This morning basal rate test

shows the basal insulin settings are correct, followed by lunch at 12pm

• If the basal rate is correct, the

glucose should remain steady

• This is ideal
• Reality is insulin requirements

vary greatly overnight

• This trace is not possible every

night for the vast majority of people living with Type 1 diabetes

Basal control

Basal insulin: cruising at the desired altitude

Turbulence in basal requirements

Stress, illness, sitting, pre-menstruation Exercise, standing, alcohol, relaxation

What would you do with the basal overnight?

Question What would you do with the basal insulin?

• 1. Increase
• 2. Decrease
• 3. Stay the same

Alcohol

When in target pre bed basal is perfect

Question What would you do with the basal insulin?

• 1. Increase
• 2. Decrease
• 3. Stay the same

Alcohol

Alcohol

When in target pre bed basal is perfect

Question What would you do with the basal insulin?

• 1. Increase
• 2. Decrease
• 3. Stay the same

Alcohol

• If an unexplained night-time

hypos occurs, reduce the

• vernight basal rate

immediately the following night

• More information on

hypoglycaemia can be found in Dr Pratik Choudhary’s Hypoglycaemia module

Hypoglycaemia

Conclusion

• FreeStyle Libre allows you to see your glucose trend
• vernight
• The aim of basal insulin is to keep the glucose stable
• vernight, most nights
• There are factors other than insulin which can send

the overnight glucose up and down